title: Improved long-term survival for rheumatic mitral valve repair compared to replacement in the young.
abstract: BACKGROUND
  Mitral valve (MV) repair offers potential advantages over replacement in patients with rheumatic heart disease (RHD). We present the first long-term study that compares MV repair with replacement in children with RHD.
  
  
  RESULTS
  Single institute retrospective review of patients with RHD under 20 years of age, who underwent their first isolated MV surgery between 1990 and 2006. Of the 81 patients, 98% were Māori or Pacific Islander. The median age was 12.7 (3-19) years. The MV was repaired in 59%, a mechanical valve replacement (MVR) took place in 35% and bioprosthetic valve replacement in 6% of the patients. Follow-up data were available for 91.4% of the patients with mean follow-up of 7.6 years (range 0-19.4 years), a total of 620 patient years. Actuarial survival at 10 and 14 years for patients with MVR was 79% and 44%, compared to 90% and 90% for patients who underwent repair (P = .06). Actuarial freedom from late reoperation at 10 and 14 years for patients with MVR was 88% and 73%, compared to 76% and 76% for patients with repair (P = .52). Actuarial freedom from thrombotic, embolic, and hemorrhagic events at 10 and 14 years for patients with MVR was 63% and 45%, compared to 100% and 100% for patients with repair P < .01).
  
  
  CONCLUSIONS
  This study shows that MV repair is superior to replacement for RHD in the young with follow-up to 19 years. Repair offers a survival advantage, greater freedom from valve-related morbidity, and long-term durability that equals that of MVR.
authors.affiliation: Green Lane Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Bo
authors.initials: B
authors.lastname: Remenyi
authors.forename: Rachel
authors.initials: R
authors.lastname: Webb
authors.forename: Tom
authors.initials: T
authors.lastname: Gentles
authors.forename: Peter
authors.initials: P
authors.lastname: Russell
authors.forename: Kirsten
authors.initials: K
authors.lastname: Finucane
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Nigel
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D009520:New Zealand; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult
keywords: mitral valve; pediatrics; rheumatic heart disease; surgery; valvuloplasty